12 June 2012

Our entire hospital booted up a new Electronic Medical Record (EMR), from top to bottom, we are now an Epic facility. Today was my first shift in the ER after go-live, which was Saturday. Holy smokes, what a project it was to get it up and running. This system now runs everything in the hospital, from the ER to the OR to the wards, to the business and billing function, stocking, housekeeping, nursing, RT/PT/OT, social work — EVERYTHING. And we went live with a "big bang," all at once.

The good news? It went, if not perfectly, very well, and certainly better than expected. There were no major issues, which was a huge relief since the programming team was frantically building critical elements until the day before go-live. It's really disconcerting to sit with tutors three days before the event, ask how to order labs, and be told, "well, this is how you'll do it, but you can't do it now since that module is still in development." But to their credit, they got it done and it works.

The bad news? Not too much, other than the fact that the system is massive and really, really complex. This makes the learning curve super steep, and the impact on operations during the first week has been substantial. We have lots of support, with tutors and specialists standing by our elbows guiding us through each workflow, but every simple little thing takes forever as you're learning it.

How complex is this system? Just my interface, and I am but one provider of many classes, has by my count at least 15 different screens I interact with, and each screen has dozens of widgets and elements I need to operate. Worse, the behavior of each widget isn't always consistent from one context to the next. There are multiple ways to get some common tasks done, which is nice, but it's so easy to get lost in all the menus, windows and panes. It's pretty overwhelming, and mistakes can be frustrating to undo.

And I'm an eager adopter, a computer savvy guy. For me to be completely on overload, I pity some of the less nerdy folks working in our hospital.

I don't want you to think I'm down on this system. I loved our old EMR, Picis, because it was super elegant and simple and easy to get stuff done. This is much more intricate, which is a big challenge to learn but — I think — will be more powerful once I get it mastered. I can see myself being much more efficient than I was before within a couple of months. I hope.

For those who are interested, we have the ASAP module with the Notewriter function, but my off-the-cuff reaction is that Notewriter is utter crap and I don't think I'll ever use it. I've constructed a H&P skeleton with a lot of datapoints auto-populated from the chart and I am using Dragon dictation. The current release of Dragon seems much more accurate than older ones I have used, and there were Dragon experts there giving us lots of tips & tricks to really take advantage of the shortcuts available.

For example, I can order meds & labs verbally, and even common lab panels, using the mic. I can also drop in a standard age/gender/complaint specific physical exam with three words. (IMPORTANT: proofread/edit the output to make sure it's appropriate for the actual patient!) Also, I've made a slew of medical decision making notes with links that pull in personal/clinical data from the chart for common situations.

So it's a powerful tool, and I may wonder how I ever got by without it in a year or two. But for now, my head is spinning and I've gotta go lie down.

[EDIT: The de-identified screenshot was provided by the nice folks at Epic.]

16 comments:

Congrats! As a former Epic employee I continue to have enormous respect for the complexity of the work they're doing at every level.

I know that the notes may seem like they aren't quicker to write but give the dot phrases and other SmartTexts and SmartPhrases a try (I think that's what they were called; it's been a couple of years). NoteWriter is good but my particular customer never used them. I feel like NoteWriter would win on a tablet type of environment (and Canto was a work in progress when I left; I hope that they get their full blown EMR on iPad soon because I think that's a perfect device for the field).

I work for another local hospital and we just went live four weeks ago with Cerner Powerchart CPOE. I am glad to hear things are going well with your system. At four weeks out things are settling down quite a bit and people are getting the hang of it, and now they are clamoring for changes and additions to the system to make it even smoother. Hope at week four you're doing that, too (I'm sure you will be, given your tech savvy abilities)!

As an EPIC user (and fanboy, if there is such a thing), welcome to the club.

I've been using it since 2008, and think, given its warts, it's still terrific.

I echo your commenter recommending dot phrases, a great way to get time back in data entry. I understand your reticence to use the native notewriter (we don't, we use free text with pulled in data elements and have scribes), just understand that when it comes time to do reports on '40 to 50 year olds with CP who took an aspirin PTA" best of luck with the free text searching. It can be done, but it's NOT easy (I'm told).

We migrated to Epic from Medhost in November. Our team did a great build with a ton of point and click options and our scribes fly through the charting. Our team also did order sets so we just type in "chest pain" and all our standardized stuff gets automatically ordered. We also have a ton of dot phrases, so you can type in ".ddxabdpain" and the abd ddx pops in. All is fully customizable for us based on preferences. I hated it at first but love it now

Problem with the epic build that you and I (in portland) are dealing with is they built it to suit so many hospitals instead of doing each hospitals build individually. Much more complicated than it needs to be. I guess it was cheaper that way but it sucks for the end user. When you go to order a lab for example you have to choose from a menu that includes the ordering style for every hospital in the system from Alaska down to Northern CA I think. You need to remember and find which one is the correct version for your facility. Stupid stupid stupid. Very disrespectful of the physicians time if you ask me.

We went live on Epic three years ago. The older docs are still protesting, but their voices are getting quieter and quieter. We're a teaching hospital, so they just get their residents to enter their orders, etc.

I <3 Epic. I love it enough to use a silly heart. I'm an RN and we don't use Notewriter; the docs mostly use smartnotes to populate their H&Ps. It's got a few warts, but overall it is light years ahead of any other system that is being used locally.

I work in the ER and we just transitioned to epic last month. I am trying to use smart phrases and such to help with speed. Will you explain how you use Dragon dictation to order labs? I have the Dragon app on my iphone but haven't really used it much. Does the app need to be on your computer or phone? Any advice would be greatly appreciated!

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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